Wound treatment: printing instead of grafting

Currently, wound care is limited to either waiting for wounds to heal while keeping them clean and free of infection or using grafts from the patient’s own body to cover larger defects. With the ongoing development tissue engineering and bioprinting, there could be a third option in future: Will we be able to print new tissue directly in the OR to cover surgical wounds?

At MEDICA 2022, Inventia Life Science presented a robotic arm acting as a 3D bioprinter that prints biomaterials directly on wounds to support the healing process. MEDICA-tradefair.com spoke to Jason Leavens about the possible uses of this bioprinter, how the process works and how patients would benefit.

Mr. Leavens, you are showing the therapeutic use of a robotic arm here at MEDICA 2022, the KUKA LBR Med – what does it do?

Jason Leavens: We use it as the platform for our 3D bioprinter that works in a surgical setting to print biomaterials and cells directly on a patient’s wound. This 3D bioprinting technology could be used to treat different skin defects like surgical excisions of non-malignant tumors, third degree burns, pressure ulcers and the like. We limited our first indication to full-thickness skin wounds, i.e., wounds where the dermis and epidermis are not present anymore. This is where the benefits of 3D bioprinting seem to be more focused than in other indications like split- or partial-thickness wounds.

We hope that we will be able replace what is typically a two-stage process in wound healing, where regeneration of the dermis is first performed prior to a second operation in which the epidermis is typically reconstructed with a skin graft. Our application, using this robotic platform, allows the deposition of biomaterials and cells in a skin-like tissue construct. This should enable those two key components of the skin to be printed in a single operation.

How would this improve wound treatment?

Leavens: We are starting with low-complexity wounds, but we anticipate that the benefit will both be in the reduced number of surgeries and the delivery of the hydrogel matrix, meaning the biomaterial along with the cells. We also anticipate a reduced time to heal and thus, less time at the hospital for patients.

But the ultimate goal of this platform it to reduce scarring. Patients would have the benefit that the treatment could promote the right regenerative phenotype. This is triggered by these biomaterials and cells in such a way that the skin is restored as healthy and normal rather than scarred.

How does the printing process work?

Leavens: Our printer uses drop-on-demand-printing. This works like inkjet printing. Small droplets of biomaterial components are ejected from the printhead: First, component A is deposited on the wound; when a drop from component B lands on top of this, there is an instantaneous reaction where cross-linking and a gelation reaction between the components occur.

This allows accurate, precise control of material and cell deposition. It is also known as a very good way to deliver cells without causing damage to them through shear stresses in the fluid pathway. It is also a contact-free printing process, meaning there is only a minimal manipulation of the wound during the printing process.

What kind of cells would be used?

Leavens: We are looking at the patient’s own cells in the first application. This usually involves taking a small skin biopsy, from which cells are extracted. The key cells for the printing process are keratinocytes and fibroblasts as they are key for the regeneration of the two levels of the skin: fibroblasts for the dermis and keratinocytes for the epidermis.

We are developing this as a platform technology, so it is certainly on the horizon to also use cells from other sources like allogeneic cells provided by cell banks or cultured autologous cells, meaning ones from the patients themselves. They would be extracted before the actual surgery and then expanded in a cell culture to provide a larger number of cells.

How far along are you in development?

Leavens: We are currently conducting preclinical studies. Our first clinical study is planned to start in December 2023. We are essentially in a research phase but are currently moving steadily towards commercialization.

At MEDICA 2022, you were exhibiting at the stand of robot manufacturer KUKA and were taking part in the KUKA Innovation Award. What does this mean to you?

Leavens: The support from KUKA has certainly assisted the development of our application significantly. We have been able to fast-track our platform development because KUKA have generously loaned the LBR Med robotic arm, to us and they did for all of the finalists in the KUKA Innovation Award. The LBR Med is an out-of-the-box robotic arm that is ISO 60601 compliant and follows the safety standard for electro-medical devices. And we have full support from their technical staff which has been really amazing.

What feedback did you receive from the visitors at MEDICA?

Leavens: We were certainly prepared for a lot of questions about the application because not too many people are familiar with 3D bioprinting and tissue engineering, and a lot of people were quite excited about the possibilities the technology could offer. Also, many were interested in when it will become a commercial reality. It is very encouraging to get this kind of feedback from potential distributors and partners, even though it is probably a little too early for us to make this kind of discussions more formal. But we are looking forward to being able to use these types of contacts to move our work forward in the near future.